Simultaneous Integrated Boost Radiotherapy and Concurrent Chemotherapy for Locally Advanced Esophageal Carcinoma

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE1/PHASE2

Total Enrollment

80 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-01-31

Study Completion Date

2016-12-31

Brief Summary

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This phase Ⅰ/Ⅱ trial is designed to explore a higher radiation dose by using IMRT simultaneous integrated boost technique with or without concurrent chemotherapy for locally advanced esophageal carcinoma.

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Detailed Description

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Despite the application of IMRT and the studies of concurrent chemoradiation in esophageal carcinoma, which improves 5-year survival rate from 10% to 20%-40% and decrease recurrence rate from 80% to 50%-60%, local recurrence remains to be the most common failure pattern. Therefore, enhancing local control is the key to obtain a better survival.

A phase Ⅱ study of radical radiotherapy with IMRT simultaneous integrated boost technique and concurrent chemotherapy for esophageal carcinoma use the same radiation dose as the high dose arm in RTOG 94-05, which reveals an significantly improved median survival time of 23 months and 3-year overall survival rate of 44.4%. This study implies the simultaneous integrated boost technique may be effective to some extent. But the question is how to identify patients who may gain potential benefits, and whether this therapeutic model can be copied in the specific situation in China? Few adverse effects such as perforation, hemorrhage and stenosis was reported, mainly owing to the lack of cases. For widely application of this new technique in the clinic, more studies need to be conducted in the future to obtain sufficient evidence.

The current IMRT can simultaneously achieve prophylactic dose (DT 50Gy) and radical dose (DT 60-64Gy) in respective target volume by using inverse intensity-modulated planning system. However, it is still controversial on whether esophageal carcinoma can receive prescription dose more than 2.0Gy each time. That is to say, it is challengeable to find an optimal fraction dose and total dose between tumor and adverse effects. For this reason, the dose escalation trial is to be conducted to explore the clinical value and optimal dose to esophageal carcinoma with different radiosensitivity, and also provide data support for phase Ⅲ clinical trials.

Conditions

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Esophageal Neoplasms

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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Radical 2.14

Radiation：Patients undergo radiotherapy once daily 5 days a week for an average of 5.5 weeks in the absence of disease progression or unacceptable toxicity. IMRT simultaneous integrated boost technique is used to achieve a prophylactic dosage and radical dosage of 1.8Gy and 2.14Gy once respectively.

Concurrent chemotherapy:Patients may receive a dosage range of Paclitaxel from 45 to 60 mg/m2 and Nedaplatin 25mg/m2 per week in the following 5 weeks after enrollment with radiotherapy at the same time in the absence of disease progression or unacceptable toxicity.

Group Type EXPERIMENTAL

IMRT simultaneous integrated boost

Intervention Type RADIATION

To achieve a prophylactic dosage and radical dosage once respectively

Paclitaxel

Intervention Type DRUG

Paclitaxel from 45 to 60 mg/m2 per week concurrent with radiotherapy for 5weeks

Nedaplatin

Intervention Type DRUG

Nedaplatin 25mg/m2 per week concurrent with radiotherapy for 5weeks

Radical 2.17

Radiation：Patients undergo radiotherapy once daily 5 days a week for an average of 5.5 weeks in the absence of disease progression or unacceptable toxicity. IMRT simultaneous integrated boost technique is used to achieve a prophylactic dosage and radical dosage of 1.8Gy and 2.17Gy once respectively.

Concurrent chemotherapy:Patients may receive a dosage range of Paclitaxel from 45 to 60 mg/m2 and Nedaplatin 25mg/m2 per week in the following 5 weeks after enrollment with radiotherapy at the same time in the absence of disease progression or unacceptable toxicity.

Group Type EXPERIMENTAL

IMRT simultaneous integrated boost

Intervention Type RADIATION

To achieve a prophylactic dosage and radical dosage once respectively

Paclitaxel

Intervention Type DRUG

Paclitaxel from 45 to 60 mg/m2 per week concurrent with radiotherapy for 5weeks

Nedaplatin

Intervention Type DRUG

Nedaplatin 25mg/m2 per week concurrent with radiotherapy for 5weeks

Radical 2.21

Radiation：Patients undergo radiotherapy once daily 5 days a week for an average of 5.5 weeks in the absence of disease progression or unacceptable toxicity. IMRT simultaneous integrated boost technique is used to achieve a prophylactic dosage and radical dosage of 1.8Gy and 2.21Gy once respectively.

Concurrent chemotherapy:Patients may receive a dosage range of Paclitaxel from 45 to 60 mg/m2 and Nedaplatin 25mg/m2 per week in the following 5 weeks after enrollment with radiotherapy at the same time in the absence of disease progression or unacceptable toxicity.

Group Type EXPERIMENTAL

IMRT simultaneous integrated boost

Intervention Type RADIATION

To achieve a prophylactic dosage and radical dosage once respectively

Paclitaxel

Intervention Type DRUG

Paclitaxel from 45 to 60 mg/m2 per week concurrent with radiotherapy for 5weeks

Nedaplatin

Intervention Type DRUG

Nedaplatin 25mg/m2 per week concurrent with radiotherapy for 5weeks

Neoadjuvant 2.14

Radiation：Patients undergo radiotherapy once daily 5 days a week for an average of 4.5 weeks in the absence of disease progression or unacceptable toxicity. IMRT simultaneous integrated boost technique is used to achieve a prophylactic dosage and radical dosage of 1.8Gy and 2.14Gy once respectively.

Concurrent chemotherapy:Patients may receive a dosage range of Paclitaxel from 45 to 60 mg/m2 and Nedaplatin 25mg/m2 per week in the following 4 weeks after enrollment with radiotherapy at the same time in the absence of disease progression or unacceptable toxicity. Assessment of surgery: Patients eligible for surgery after multiple disciplinary consultation will receive esophagectomy after a 4-6 weeks break after chemoradiation in the absence of any contraindication.

Group Type EXPERIMENTAL

IMRT simultaneous integrated boost

Intervention Type RADIATION

To achieve a prophylactic dosage and radical dosage once respectively

Paclitaxel

Intervention Type DRUG

Paclitaxel from 45 to 60 mg/m2 per week concurrent with radiotherapy for 5weeks

Nedaplatin

Intervention Type DRUG

Nedaplatin 25mg/m2 per week concurrent with radiotherapy for 5weeks

Esophagectomy

Intervention Type PROCEDURE

Radical esophagectomy 4-6 weeks after neoadjuvant therapy

Interventions

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IMRT simultaneous integrated boost

To achieve a prophylactic dosage and radical dosage once respectively

Intervention Type RADIATION

Paclitaxel

Paclitaxel from 45 to 60 mg/m2 per week concurrent with radiotherapy for 5weeks

Intervention Type DRUG

Nedaplatin

Nedaplatin 25mg/m2 per week concurrent with radiotherapy for 5weeks

Intervention Type DRUG

Esophagectomy

Radical esophagectomy 4-6 weeks after neoadjuvant therapy

Intervention Type PROCEDURE

Other Intervention Names

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Taxel

Eligibility Criteria

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Inclusion Criteria

* Diagnosis of clinical stage T2-4N0-1M1a untreated squamous esophageal carcinoma
* KPS≥70
* Adequate organ function
* No known history of drug allergy

Exclusion Criteria

* Known drug allergy
* Insufficient hepatorenal function
* Severe cardiovascular diseases, diabetes with uncontrolled blood sugar, mental disorders, uncontrolled severe infection, active ulceration which need intervention.

Minimum Eligible Age

18 Years

Maximum Eligible Age

72 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No